-
Left shift OBC
- Fetal HgB
- Metabolic Alkalosis
- temperature
- 2,3 DPG
-
Right shift OBC
- Metabolic acidosis
- temperature
- High altitude
- Exercise
- 2,3 DPG
-
If CKD and giving EPO hgb should be?
11-12 g/dL
-
Mental status changes, cherry red lips, hypoxia. Dx? Tx?
CO poisioning
100% O2
-
Hemolytic anemia & LDH level
LDH
-
Schistocytes seen in:
- DIC
- TTP
- HUS
- Hemolytic Anemia
-
4 Microcytic Anemias
- Iron deficiency
- Sideroblastic anemia
- ACD
- Thalessemia
-
Do not take supplemental iron with
Divalent cations (mag, ca)
-
Causes of sideroblastic anemia
-
Abdominal pain, arthralgia, impaired short term memory, developmental delay, peripheral neuropathy. Dx? Tx?
Lead poisoning
- Remove lead source
- EDTA
- Succimer
- Dimercaptosuccinic acid (DMSA)
-
Basophilic stippling
- Alcohol abuse
- Lead poisoning
- Thalesemia
-
What are burton's lines
Gingivial lead lines found in lead poisoning
-
Chelator of lead poisoning when levels are?
80 ug/dL
-
Decreased EPO, increased hepcidin, anemic with hx of RA
ACD
-
Causes of drug induced hemolytic anemia
- Penicillins
- Quinidine/Quinine
- Methyldopa
- Cephlasporins
- NSAIDs
-
Blood smear of drug induced hemolytic anemia
-
Pathology behind drug induced hemolytic anemia
Bind to RBC membrane & cause oxidative destruction
Produce antidrug antibodies, immune complexes that fix complement or induce anti-Rh antibodiea
-
Treatment for drug induced hemolytic anemia
Stop offending agent!
-
Pathology of immune hemolytic anemia
- Anti-RBC antibodies
- Autoimmune dz
- Drug induced
-
Types of immune hemolytic anemia
- Warm: IgG-SLE
- Cold: IgM-mycoplasma, EBV, HIV
-
Treatment of immune hemolytic anemia
- Corticosteriods
- Avoid cold exposure
- Stop offending agents
- Splenectomy if persistent
-
Pathology of mechanical hemolytic anemia
RBCs broken down by turbulent flow
Due to prosthetic heart valves
-
Blood smear of mechanical hemolytic anemia
Schistocytes
-
Pathology of hereditary spherocytosis
Defect in RBC membrane (ankyrin)
-
Test for hereditary spherocytosis
Increased osmotic fragility
-
Symptoms of hereditary spherocytosis. Treatment
- Hepatosplenomegaly
- Calcium bilirubinate stones
Splenectomy
-
Pathology of G6PD deficiency
Deficient enzyme which is required to repair oxidative damage to RBCs.
Ingesring oxidant causes excessive RBC hemolysis
-
Triggers for G6PD deficiency
- Dapsone
- TMPSMX
- Primaquine
- Fava Beans
- Quinine/Quinidine
- Sulfa Drugs
- Nirtofurantoin
- High dose ASA
-
G6PD deficiency blood smear
-
Tests for G6PD deficiency
- Low G6PD
- Heinz body prep: screen
- Enzyme assay: confirm
-
Treatment of G6PD deficiency
- Avoid oxidants!
- Transfusion if severe
-
Hemolytic anemia with + Coombs test
-
Causes of B12 deficiency
- PA
- Inadequate intake
- Ileal resection
- Bacterial overgrowth in GI
- Diphyllobothrium Latum
-
Treatment of Diphyllobothrium Latum
Praziquantel
-
Drugs causing aplastic anemia
- Chloramphenicol
- Sulfonamides
- Phenytoin
- Chemo
-
Bone marrow biopsy of aplastic anemia
- Hypocellularity
- Fatty infiltrate (adipocyte)
- Pancytopenia
-
Triggers of sickling
- Acidosis
- Hypoxia
- Dehydration
-
Radiology of sickle cell
- Fish mouthing of vertebrae
- Lung infiltrates in acute chest syndrome
-
Sickle cell should be vaccinated against
-
Prophylactic treatment of sickle cell pts till 5 with what?
Penicillin
-
Causes of lympopenia
- Increased cortisol
- Chemo
- Radiation
- Lymphoma
-
Eosinophilia causes
- Addisons
- Neoplasm
- Asthma
- Allergic drug rxn
- Collagen vasc dz
- Transplant rjxn
- Parasitic infxn
-
Types of hypersensitivity rxns:
- I: Anaphylactic
- II: Complement mediated
- III: Immune Complex mediate
- IV: Delayed
-
Type I hypersensitivity: mediated by, mechanism, example
IgE antibody to mast cell
- Mast cell degranulation
- Histamine release
- Anaphylaxis
- Allergic rhinitis
- Asthma
-
Type II hypersensitivity: mediated by, mechanism, example
IgM & IgG against self
Allergens react with antibodies to initiate complement cascade
- Drug induced or immune hemolytic anemia
- Hemolytic dz of newborn
- Goodpasture
- Rheumatic Fever
- ITP
- M. Gravis
- Graves
- B.P. & P.V.
-
Type III hypersensitivity: mediated by, mechanism, example
IgM & IgG complexes
Antibodies for immune complexes with allergens
- Arthus rxn
- Serum sickness
- Glomerulonephritis
-
Type IV hypersensitivity: mediated by, mechanism, example
T cell & macros
T cells present allergens to macros & secrete lymphokines
- Allergic contact dermatitis
- Transplant rejection
- PPD testing
-
Monitor LMWH with
Factor 10 A
-
Do not start warfarin for a thrombus until after starting LMWH or until PTT is therapeutic on unfractionated heparin bc?
Warfarin inhibits protein C & S and can cause short period of hypercoagulability immediately after therapy is started
-
Labs of vWd
- PTT, BT,
- vWF factor 8
- ristocetin cofactor activity
-
-
Vitamin K deficiency labs
-
Hemophilia labs
- PTT
- Normal PT, normal bleeding time
- factor 8 or 9
-
DIC labs
- platelets, fibrinogen
- PT, PTT, D-dimer
-
Treatment for DIC
- Underlying cause
- Platelets
- FFP
- Cryo
-
Definition of HIT
Sudden in platlet level by more than 50%
-
Gold standard to dx HIT
- + serotonin release assay
- (but not used due to cost)
- + Heparin induced aggregation assay
-
Treatment of HIT
- Dc all heparin
- Start lepirudin or fondaparinux
-
Patho ITP & platelet count
Autoimmune B cell pdxn of antiplatelet antibodies
50,000
-
Treatment of ITP
- Kids: self limited
- Adults: corticosteriods, delayed splenectomy, IVIG, plasmapheresis, recombinant factor 7a
-
HUS triad
- Hemolysis
- ARF
- Thrombocytopenia
-
TTP Pentad
- Hemolysis
- ARF
- Thrombocytopenia
- Fever
- AMS
-
Treatment of TTP-HUS
- Corticosteriods
- Plasmapheresis
-
HELLP treatment
- Induce delivery if fetus 35wks
- Anti HTN meds& steriods if preterm
-
Cause of sepsis in IVDA
Staph aureus
-
SIRs criteria
- or Temp
- Tachypnea
- Tachycardia
- Leukocytosis, leukopenia, or bandemia
-
Pressor for sepsis
Norepi
Also give colloid & steriods
-
Med beneficial for pt with multiorgan failure caused by septic shock
Human activated protein C
-
Chills, periodic fever, diaphoresis, HA, myalgia, fatigue. Dx? Test?
- Malaria
- PCR for plasmodium
-
Treatment of malaria
- Chloroquine
- Quinine
- Primaquine
- Atovaquone-proguanil
- Mefloquine
-
Labs with mono
- + heterophile antibodies
- + EBV serology
- WBC
- LFTs
- lymphomicytes
- Hemolytic Anemia
- Thrombrocytopenia
-
Mono pts can return to noncontact sports in how long?
3 wks
-
Mono pts can return to contact sports in how long?
4 wks
-
Screening & confirmatory test for HIV
ELISA western blot
-
Concern for HIV transmission via accidental needle stock. Treatment?
Prophylactic zidovudine & lamivudine
HIV antibody tests @ 6 wks, 3 mos, 6 mos
-
Start antiretroviral treatment for HIV if:
- 1. CD4 count 350
- 2. Viral load 20,000
- 3. Symptomatic development of opportunistic dz
-
HAART
2 NRTi's & protease i/NNRTi
Need 3 drugs!!
-
Antibiotic prophylaxis cd4 200
- Bactrim for PCP
- Clarithromycin or azithromycin for MAC
- INH when contacts have TB
-
HIV pathogens at CD4 500
- Herpes Zoster/Simplex
- Kaposi's Sarcoma
- Parasiric diarrhea- isospora, strongyloides, cryptosporidium
-
See wasting syndrome at what CD4 count
350
-
Coccidioidomycosis seen at what CD4 count
250
-
HIV pathogens at CD4 200
- AIDs dementia
- Bacterial pneumonia
- Candida esophagitis
- Cervical Cancer
- PCP
- TB
-
Histoplasmosis seen at what CD4 count?
150
-
HIV pathogens at CD4 100
- Lymphoma
- PML
- Cerebral toxoplasmosis
-
HIV pathogens at CD4 50
-
hgb & hct, RBC mass, EPO, BM shows hypercellular marrow
Polycythemia Vera
-
Treatment of Polycythemia Vera
- Serial phlebotomy
- Antihistamines
- ASA
- Hydroxyurea
Do not give iron!!
-
MC type of hodgkins
Nodular sclerosing
-
Reed sternberg cells
Hodgkins lymphoma
-
(8,14) translocation
EBV-Burkitts
-
BM showing blasts of myeloid origin & staining with myeloperoxidsse & Auer rods
AML
-
Proliferation of mature B cells, WBC, smudge cells
CLL
-
Proliferation of mature myeloid cells, hx radiation exposure. WBC, LAP
CML
-
Pathognomonic translocation for CML
Philadelphia chromosome t(9, 22)
BCR-ABL fusion gene
-
BM lymphocytic infiltration
CLL
-
BM granulocyte hyperplasia
CML
-
Treatment for CML. Complications.
Imatininb
Blast crisis
-
Proliferation of B cells, massive splenomegaly but no lymphadenopathy
Hairy cell leukemia
-
Fanconi anemia
- AR
- Bone marrow failure-pancytopenia
- Short stature
- Abnormal skin pigmentation
- Horseshoe kidney
- Cafe au lait
- Thumb abnormalities
-
Diamond blackfan anemia
- Pure RBC anemia
- (defect in erythroid progenitor cells)
- Craniofacial abnormalities
- Thumb abnormalities
- MR
- Hypogonadism
- Heart murmur
BM- activity, EPO
-
Neuroblastoma tumor of?
Neural crest cells in adrenal glands or sympathetic ganglia
-
Risk for neuroblastoma
- NF
- Tuberous Sclerosis
- Pheo
- Beck-Wiedmann
- Turner's
- Low folate in mom
-
Symptoms of neuroblastoma
- Abd distension & pain
- Wt loss
- Bone pain
- Abd mass
- HTN
- Horner's
- Proptosis
- Movement disorder
-
Labs for neuroblastoma
VMA & HVA in 24hr urine
-
Rhabdomyosarcoma
Tumor of striated mm in kids
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